The more I thought about the last post and Sue Llewelyn’s analogy of clinical managers as two way windows, the more I realised it was wrong. For me at least.

Certainly a clinical manager can allow and transmit vision (knowledge) to and from both sides of the “divide”, the insights one being more apparent to the other. But there I think the analogy starts to fail. Once again I accept that this may be due to my experiences but if an analogy is to be worthwhile it must work beyond simply those who describe it.

If one is inside a building looking out, no matter how big the window, the view is limited by the window itself. Similarly, no matter how close one gets to the window only one room inside the building will be visible. that is if the window is even on the ground floor! I’ll let you make your own translations into the experience of managers and clinicians.

My proposal is that clinican managers should be like a website.

It’s all about communication and information, accessibility, and development. And if the website isn’t working properly, or providing the right information, the appropriate support or communication portal, it can be upgraded and added to. It doesn’t have to be all singing and all dancing with java apps and downloads everywhere; it has to be personal and effective, professional and online.

Sue Llewelyn in her paper, “clinicians as medical managers,” addresses some of the issues of doctors in roles of management. At the centre of her thesis is the use of analogy; the clinician manager as a two way window. This she asserts allows each group to effectively view the other through the faciliation of the window. The suggestion is, that originating from a medical background the window will garner respect from clinical colleagues offering medical insight into the world of management and working within management gain respect from managers and offer insight into the world of medicine from management.

The topic of the clinician-manager interface seems to come up a lot in conversation around me, even without me bringing it up. Doctors want to talk about it; most have strong opinions on the matter. There’s alway a lot of negativity and, a little respect here please people, I always try to turn the conversation towards positivity and solutions for the problem rather than simply allowing the routine regression to negativity and criticism.

Recently I think I have hit on the problem. It’s not about respect, it’s not about experience, it’s not about understanding or insight, authority or knowledge, hieracrchies, budgets, control or indepencence. It is not about departmental interactions, committees or working parties, cascaded emails or a newsletter stapled to your payslip. It’s not about looking.

It’s about communication.

Yes, it is a complex professional bureaucracy with multi-faceted relationships and interactions but at the very centre of them, and of course every relationship, is communication. Without effective communication every relationship is doomed whether that is between kids in the playground, star crossed lovers, governments or even between clinicians and management. And the key word here is between.